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NPI Code Detail

MEDICARE: C O R E ABA

MEDICARE: C O R E ABA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1912328477
Entity Type Code : Organization
Provider Name (Legal Business Name) : C O R E ABA
Provider Business Mailing Address
First Line : PO BOX 1004
Second Line :
City : BETHEL
State : CT
Zip : 06801-6004
Country : US
Telephone Number : 860-946-0362
Fax Number : 203-403-6686
Provider Business Practice Location Address
First Line : 24 STONY HILL RD FL 1
Second Line :
City : BETHEL
State : CT
Zip : 06801-1166
Country : US
Telephone Number : 860-946-0362
Fax Number : 203-403-6686
Authorized Official
Title or Position : BEHAVIOR ANALYST
Name : ELIZABETH CLOSIUS SMITH
Credential : M.S., BCBA
Telephone Number : 860-946-0362
Provider Enumeration Date : 12/30/2013
Last Update Date : 11/10/2021

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Directions to “C O R E ABA ” Practice Location

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